Origins of Nurse-Midwifery in the United States and Its Expansion in the 1940s

Katy Dawley, CNM, PhD


J Midwifery Womens Health. 2003;48(2) 

In This Article

Abstract and Introduction

This article reviews the origins of nurse-midwifery in the United States during the early decades of the 20th century and explores professional expansion between 1940 and 1950. Nurse-midwifery emerged from the vision of public health nurses, obstetricians, and social reformers concerned about high maternal and infant mortality rates at the turn of the century. Desirous of promoting child health, they provided prenatal care for pregnant women and assisted physicians, while also supporting women during labor and birth at home. Seeking to expand their specialty by introducing nurse-midwifery, they joined the campaign to eliminate traditional immigrant and African American midwives. By the early 1930s, there were only two sites for the practice of nurse-midwifery in the United States: Frontier Nursing Service and Maternity Center Association. Over the next 20 years, nurse-midwifery expanded in response to physician shortages, the emergence of a childbirth education movement, and women's demands for participation in birth. In the 1940s, the greatest expansion occurred in the South and Southwest in home birth, birthing centers, and an occasional community hospital.

At the beginning of the 20th century, 50% of all babies in the United States were born into the hands of a midwife. Most practicing midwives were either immigrants from Europe or Mexico, or southern-born African Americans. Those who learned their midwifery in Europe were very well educated compared to U.S. trained physicians attending women in childbirth during the same period.[1,2,3] African American and Mexican American midwives were usually apprentice trained, and European midwives were more likely to have had a formal education. By 1930, the number of midwife-attended births decreased to 15% of the total. There were several reasons for this decline, including decreased immigration, the Americanization of immigrant women and their daughters, and the campaign to eliminate midwives waged by physicians and public health reformers.[1,4,5,6] One goal of nurses involved in this campaign was to develop the specialties of maternity nursing and nurse-midwifery.[1]

This article focuses on two developments that shaped the practice of nurse-midwifery in America: its early 20th century origins and the first wave of expansion between 1940 and early 1950. Both influenced the practice of this specialty within the U.S. health care system, and they are examined in light of four key influences: 1) the strong nursing leaders who shaped the profession's early development, 2) the movement of birth from home to hospital, 3) the childbirth education movement, and 4) the reemergence of feminism. This early history provides a framework for understanding the professionalization, expansion, and barriers confronting nurse-midwifery over the last four decades of the century.

Primary sources for this research came from the American College of Nurse-Midwives Collections in the National Library of Medicine Historical Collections; Rockefeller Foundation Archives, The Rockefeller Archives Center; Maternity Center Association Archival Material; and the Medical Mission Sisters Historical Archives.


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